“Legal Eagles or Vultures”

Only a few weeks ago I was blogging about the increasing incidence of pressure sores in the NHS and how it is leading to more legal action.   (click on the ARCHIVE dated 12 February 2012 – “UNTOLD PRESSURE” ).

Now in a little publicised report by the Public Accounts Committee, boringly called “Whole of Government Accounts”, we have a more complete picture:-

  • 8,500 new claims of clinical negligence were made in 2010/11,
  • This is a 30% increase on the previous years,
  • Around £1 billion is paid out each year,
  • The NHS has to set aside £15.7 billion in claims which may be awarded against it in future years.

One of the significant reasons for the rise in claims is “claims farming” by our “no win, no fee” lawyer friends.   You have to question whether this will lead to improved care ?

                           I STRONGLY SUSPECT NOT !

  • Doctors will become more cautious,
  • More tests will be done, further delaying treatment,
  • Difficult cases will be referred to far-away specialist hospitals,
  • There will be evermore paperwork,
  • A culture of fear and blame will grow throughout the NHS,
  • Mistakes will be hidden under the carpet.

This increasingly litigious approach to health care will erode the confidence of doctors and their patients.          You go into hospital to be cured, not to come out damaged, with a compensation cheque in your hand.

Lawyers should be legal eagles – the champions of justice, but there is no virtue in legal vultures who feed off the carrion of the NHS.    One third of all compensation settlements go to lawyers in fees!

I wonder where lawyers will be able to go to get treated when they are ill?

Posted in N.H.S. | 3 Comments

“Never Been 21 or 65”

When I was young, the big age to become was 21.  It was an anchor point  in life, a bridge between childhood and adulthood.  21st birthdays were when you became a “grown up”.  Time for a big celebration —– a PARTY.  You were to be given the key of the door.  Although it was never very clear what door and I don’t think I ever got a key.

Part of the problem was that I had already left home and gone off to university before I was 21.  The other issue was that around the age of my 19th birthday, somebody changed the goal posts and 18 became the new “age of consent”.  Nobody told me what I could or should consent to, but whatever it was,   I’d missed the opportunity !    😦

So the next big birthday to look forward to is 65 when I get to retire and become a “pensioner”.  Only the Government has gone and moved those goal posts AGAIN !

This time I cheated the system and retired early when I was still only a relative youngster at 63.  I knew I must be old though, because Network Rail gave me a SENIOR rail card.  I also now get cheaper entry to art exhibitions, zoo’s and some cinemas, because almost without knowing it and certainly without any party, I have become a “concessionary”.  I am guessing that it has something  to do with my Human Right to be equal to women ?

I think it also means I have to stand outside hotels with a top hat now that I am “concessionaire”,  still I have always liked dressing up in smart uniforms.  Or is that a “commissionaire” ?  I’ll give it a go outside the Dorchester and see how I get on.

So that must be what they meant by getting the key of the door !

The other good pensioner news is that I now get free prescriptions.  So I plan to visit my GP and get a new pill every week.  I’ll be swimming in pills soon.  Then I will know I really am a pensioner at last.

The not so good news is that the Government says 70 is the new 65 and if we all continue to get older, 75 could become the new 70.

So one way or another, I don’t think I’ll ever get to be a fully fledged pensioner.

Posted in SMILES | 3 Comments

Tommy Graham’s Blogtoons on Fruit Juice

Since the GrumbleSmiles blog was started, we have been illustrating some of the posts with cartoons.  This post is the start of building a gallery of all the blogtoons.

I’ve written a series of posts on the virtues of fruit juice of just about every different variety and here are the cartoons that accompanied them.  You can find the blogs in the TAG CLOUD under the heading of “FRUITFUL RESEARCH”. 

FRUITFUL RESEARCH

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Posted in ABOUT GRUMBLESMILES | Tagged | 1 Comment

“Living in the Past”

A rather curious idea is being proposed in Switzerland in response to the increasing number of people with dementia.  A developer is planning to build a retro village in 1950’s style architecture and then staff it with carers disguised as gardeners, hairdressers and shop assistants.  The residents will be free to roam around, albeit under subtle undercover supervision.  The village will have a cinema (presumably showing old films) and shops (hopefully selling familiar old-fashioned fare not past its sell by date).  It says there will be other facilities, so how about:-

  • A TV with no remote control and just 2 or 3 channels;
  • A twin tub washing machine with no digital programmes
  • A coal or log fire instead of central heating;
  • And real money – no plastic credit cards and no credit.

Goodness knows we need all the innovation we can get to help deal with the tidal wave of dementia that is engulfing our health services.  But, I am not sure this isn’t an overly simplistic interpretation of reminiscence therapy.  Certainly it is true that it helps people to feel secure if they are in familiar surroundings which is why moving people into residential care homes is still not an ideal solution.

I wish them well, and if it works, great.

Finding out about the past lives of residents is certainly one key to tailoring a support programme for dementia sufferers but it is not the whole story. ( For more on this see my earlier post  by clicking on the TAG Cloud ” New Vision of Later Life ” – 3- Enriched Dementia Support. ) 

The title of this blog was lost in my head somewhere.  When I Googled it I found it was the title of a song by Jethro Tull.  Part of the lyrics are:-

“Outside their lives go faster,
Oh, we won’t give in,
We’ll keep living in the past.”

A member of the group, Ian Anderson, wrote these somewhat prophetic words in 1969 and they sat in my head until now.  Being reminded of them brought back happy memories of seeing Jethro Tull in my time at university in Sheffield in the 1970’s.

Remarkable serendipity – when I looked to the very next item on my Google search it was written exactly 40 years later by Dr G A Anderson.  An article in Psychology Today entitled “Why it is important to stop living in the past”.  In his words “nostalgia is bitter-sweet”.

Posted in Dementia | 1 Comment

“Untold Pressure”

An excellent article by Kate Wighton in The Daily Mail on 31st January 2012, highlighted the incidence of pressure sores in the NHS.

Without any sense of irony, it was included in the section of the paper under the banner “GOOD HEALTH“.  Nonetheless it is a first class piece of investigative journalism and deserved to receive much more attention.

Most of the factual information was dragged out of NHS hospitals using the Freedom of Information Act.  Even then some hospitals didn’t reply at all, and others claimed they did not collect the information or only had detail of the worst sores.  This is a dreadful indictment of hospital managers, their Boards and their Regulators.  In some cases it must be a deliberate attempt to hide poor performance and willful neglect.

That is why it is a pity that a paper that makes so much noise about championing its “Dignity of the Elderly” campaign, placed this article on its Inside Health pages instead of the front page.

First of all let me repeat some of the key figures in the report:-

  • 412,000 NHS patients have bedsores annually.
  • 27,000 patients died with bedsores or infected wounds in 2010.
  • This is estimated to cost £2 billion per year.

The elderly are particularly at risk because of poor circulation and limited mobility.  Bedsores can develop in as little as 4 hours, but then take weeks or months of nursing care to heal.

The Daily Mail published detailed figures from individual hospital trusts which suggests that upto 2% of patients acquire bedsores.  I must say I am surprised these figures are as low as that, given the constant stream of stories of malnutrition, dehydration and poor care that emanate from the NHS.

My own experience in the past of running nursing homes in the ExtraCare Charitable Trust, was that bedsores were given the highest attention by the nursing staff.  The figures were very low but even so were reported every month to the whole director team.  Our Operations Director, who was a former and formidable hospital matron, would personally take to task any nursing home manager whose residents acquired a pressure sore while in our care.  Almost all of our residents who suffered from pressure sores were discharged from hospital with them.  This was at a time when we looked after around 1,000 nursing home residents.

The Department of Health has belatedly announced that pressure sores will be included in a list of patient outcome measures – which is good news – but then with typically crass ineptitude goes on to suggest that hospitals will lose some of their budget if they fail to meet pressure ulcer targets.  This upside-down big stick management style will only lead to the figures being further under reported.  The hospitals with the biggest problems need help, not less money.

The common sense solution, which has been much talked about, but not effectively implemented, is to get empowered matrons out of their offices, away from paperwork and acting as nurse leaders on the wards.

A GrumbleSmiles tongue in cheek alternative would be to give free desk space on every hospital ward to no win no fee solicitors who specialise in medical negligence.

If the Department of Health just passed over a large part of the NHS budget to solicitors, I know they would be more than happy to regularly visit hospital wards and interview patients.  Perhaps they could join the doctors’ rounds and collect the data as they go along.  Then to speed up the compensation claims, patients could be given a payment for all the hospital acquired infections and pressure sores, as they are discharged.

Tagged | 1 Comment

“Confused Conclusion”

A recent study of elderly people admitted to hospital found that those affected with dementia were suffering because hospital staff have no idea how to treat them.  The study went on to suggest that hospitals should assume that all older people potentially have dementia.

I believe this is a dangerous conclusion to reach without a proper assessment.  It is perfectly natural for people who are ill and whisked into a strange environment to be dis-orientated.  When, as often is the case, they also have to wait around for hours; it is not surprising that some of them become agitated and sometimes unreasonable.  Not all confusion is the result of dementia and if staff treat elderly people automatically as if they are mentally ill, then other more treatable health conditions could be missed.

Yes, of course staff should be properly trained to look out for dementia, but they should assume elderly people are mentally aware, UNTIL they have good evidence to suggest otherwise.

About a third of all residents who are thought to have dementia are treated with anti-psychotic drugs (the chemical COSHH).  This is often for the patients’ safety, but also for the staff’s convenience.  It is restraint by another name.  Patients treated this way often become drowsy and even more confused.  Incontinence and pressure sores are frequent outcomes and the elderly person is often discharged from hospital with even more problems than when they were first admitted.

A diagnosis of dementia should only be made after careful consideration by experts.  Anything less can lead to long-term incorrect treatment and the writing off of a life.  Jumping to conclusions is not a good answer.

For other blogs on Dementia, click on “Dementia” under TOPICS

Posted in Dementia, HEALTH | 2 Comments

“Uneconomic Prediction”

I don’t venture into discussing economics in this blog because it’s not a subject I pretend to understand.  In these heady days of the credit crunch aftermath, the potential melt-down of the European Union and ever-present threat of an ongoing recession in the Western World, it is difficult to avoid the subject altogether.  Especially when it begins to talk about elderly people.

So here is my attempt at understanding an article in the financial pages of The Times on 1st February 2012 written by Andrew Clarke, a young-looking business commentator.

The report refers, in scary terms, to a prediction made by Standard & Poor’s (the most ominously named credit rating agency) that “Britain is facing a downgrade in its credit rating unless we reform the NHS – by 2050”.

The speculation by S & P is that Britain will not be able to afford the rising cost of health care and pensions, but neither will it take steps to reform the situation.  Without dramatic change, they predict Britain’s borrowing would have to increase to FOUR TIMES its current level.  THAT IS BANKRUPTCY ON A GRAND SCALE.

For every economist who thinks one thing, there is always another one who thinks the opposite, and sure enough Andrew Clarke disagrees with S & P, although he doesn’t explain why.  So Mr Clarke’s little cameo on the S & P prediction was interesting but not very enlightening.

As ever, you have to figure it out for yourself, so here is my best guess:-

Firstly, the demographics of an ageing population in the UK are quite clear – we are living significantly longer lives.

Secondly, an older population means much higher health care costs .

Thirdly, it seems inevitable that we will not generate enough new income from growth to cover the cost of state-funded health care and pensions.

S & P describe this as “an economically toxic combination”.

Three options occur to me:-

  1. Reduce pension payouts – which has already been started by extending retirement age and linking pension increases to CPI, not RPI.  Closing public sector final salary schemes is the remaining stumbling block, but inevitably it will happen.  You will also have to simultaneously reduce welfare benefits, otherwise no savings on public expenditure will result.
  2. Cut back on free health care by privatising care of the elderly, which is already happening by denial of access to good care in the NHS thereby is forcing elderly people either to pay for themselves or go without.  The missing piece in this jigsaw is the absence of an insurance product to cover long-term health care.
  3. The Dutch final solution – Euthanasia is slowly creeping through the door under the slightly more acceptable term of assisted suicide.  How long will it be before it becomes common practice to question older people in hospital about their will to live?  Indeed isn’t it already happening and aren’t we conspiring to accelerate the situation by the neglect of older people in hospital and in the community.

The grim reality of our collective head in the sand, is that if we carry on as we are, we will probably end up with all three options playing a significant part in our economic and social future over the next twenty or thirty years.

There is, I believe, a better option if we face up to the changed situation.  We have not generally saved enough in pensions to give ourselves an extended and happy old age, but many older people are home owners, with substantial accumulated equity in their homes.  They need to take control of their own lives by cashing in their wealth to buy themselves a better future.

The economy is faltering. Politicians lack the courage to lead us out of the problem.  Older people need to buy themselves a better future.

Posted in ELDERLY UK POLICY | Tagged | 4 Comments

“Southern Cross Aftermath”

The poker game that was the story of Southern Cross ended up as “pass the parcel”.  A large group of former Southern Cross residents have been handed back to their landlord – NHP, and in turn they have entered a partnership called HC-ONE.  NHP is a near-bankrupt company, which can only be still in existence because it is too difficult to close.

Their new partner is Dr Chi Patel.  He is someone whose path crossed mine for many years, while I was at the ExtraCare Charitable Trust.  I have never met him but I did see him as an influential figure in the nursing home industry.  Although he has a medical background, it was his merchant banking connections that were more significant in the growth of Court Cavendish and then Westminster Health Care.  Both became significant privately funded nursing operators mainly providing for self-funded residents.

Now he is going to require all his skills to reshape the over-leveraged NHP portfolio.  He will need to persuade the financial backers to moderate their vulture capitalist ambitions and at the same time he will have to convince impoverished Local Authorities to pay at least as much to the private sector as they pay to their own staff and to run their own homes.  Neither of these tasks will be easy to achieve, but they are the only way forward for publicly funded residents who need nursing or residential care.   Alternatively Dr Patel will have to abandon state funded residents and gradually shift his marketing efforts exclusively toward privately funded residents, which is the most likely option that he will take.  Which means in the longer term another major provider will be forced to abandon all but the highest paying state-funded residents.

His aspiration is to “provide care for his residents, that he would wish for his own mother”, which is a good place for a fresh start.  He has made this promise to relatives – it is to be hoped he can live up to this lofty ambition.

 

For earlier posts, click on “Southern Cross” in the TAG CLOUD

Posted in Nursing Homes | Tagged | 1 Comment

“Dementia Unravelled”

Only a few days ago I was writing my last blog on dementia. (look up Dementia under TOPICS)  “Dementia Puzzle” commented on a simple activity programme for sufferers of early stage dementia and I went on to talk about the ExtraCare’s Enriched Opportunities Programme which adopts a similar approach.

When I was recently on holiday in America, I opened a copy of the Daily Mail dated 4th December 2011, and low and behold there is a double page article in the health section.  It covers the experience of Ann Curtis and her daughter Joanne Knowles.  Ann had early stage dementia and Joanne, like many other relatives in similar positions, was trying to find ways to help her mother.  After the usual stumbling around with GP’s unable to effectively diagnose the condition, Ann came across “cognitive stimulation”, which is the fancy name researchers and academics have given to keeping people active mentally and physically with familiar things.

The story goes on to recount how Ann set up a small group of sufferers to meet and share activities.  Like I said previously, it is not rocket science.  What we need is an army of volunteers, like Joanne, to be encouraged to set up small projects all over the country.  We don’t need fancy names or any more academic research.  As a society we just need to get on with it.

It is clear that loneliness and isolation compound the problems of memory loss in later life.  Misdiagnosis and no diagnosis only add to the confusion about confusion.  Simple, structured and regular engagement with older people can lift many of them out of the downward spiral of despair about dementia.  Indeed evidence has shown that many of them do not have dementia at all, but may be suffering from more treatable illnesses such as depression.

Voluntary organisations such as AGE UK, need to be doing much more in this area by offering encouragement, support and opportunity to the thousands of people like Ann and Joanne.  We need as a society to mobilise more passion and compassion about an epidemic which already threatens to overwhelm the NHS and leave the elderly and their relatives stranded and alone.

Posted in Dementia | Tagged | 4 Comments

“Move to a smaller house”

We have just been given an object lesson in “how not to propose a new Government policy”.   Grab half an idea, claim it is an important new initiative, push it out to catch a headline at the start of a new year, then announce it with bold bluster and a cheery smile.

The luckless champion of this new policy is Grant Shapps – the Housing Minister.  His proposal was to encourage older people to move out of their large family houses into smaller homes.  As an approach it has great merit and it is something I have been doing for the last thirty years.  However, the inept way in which this initiative was launched means that it was greeted with howls of derision and scare-mongering headlines.

The consequence of this three steps forward, two steps back accidental strategy is that little is likely to come from it and an opportunity to address a vitally important issue for the elderly and the country as a whole, has been lost.

Let’s go back a few months and look at the clarion call that first revived this issue in the headlines.  In October 2011, a little known and curiously named think tank “The Intergenerational Foundation” published a report crassly entitled “Hoarding of Housing”.  It highlighted some significant figures:-

  • There are 25 million surplus bedrooms in under-occupied houses in England;
  • 33% of all households are under-occupied;
  • Downsizing amongst the over 65’s has stagnated.

Unfortunately, the headline of the report guided shallow minded journalists into focussing on how the elderly could be driven from under-occupying their family homes.  The spiteful thought planted in the full text of the 34 page report was that older people were “hoarding” their houses at the expense of families who desperately need them.  This gross distortion of the situation meant that any prospect of the report being treated seriously was rapidly dismissed by blizzard of newspaper shouts of “shame”.  No housing minister could ever admit to championing this report.  Mr Shapps said “we do not agree that older people should be taxed or bullied out of their homes”.

All was not entirely lost, a spark was kindled and the Government quickly reached for another idea.

Redbridge Local Authority deserves credit for bringing forward this initiative.  It enables elderly owner occupiers to move into more suitable smaller houses without having to sell their home.  The Local Authority will then rent the larger house to a family and pass on the rental income to the elderly person.  In principle it seems like a useful option which may entice a few people to move, although their extra income may well disqualify them from welfare support which owning their own home would not have.

Mr Shapps has thrust this idea into the limelight as an example of how his new strategy for reducing under occupation of housing can work.  However, it feels more like clutching at straws rather than a carefully considered housing strategy.  By concentrating on under-occupation it immediately puts people on the back foot.  The press starts to talk about compulsion and this just engenders fear amongst the elderly.  An almost hysterical full-page article in the Daily Mail by Brenda Almond, a “nutty” Professor of Moral and Social Philosophy at the University of Hull, talks about the prospect of elderly people being:-

  • “urged by municipal meddlers to get out”
  • “properties being commandeered”
  • “homeowners pulling down walls to reduce the number of bedrooms”

What silly nonsense!  But it’s only given a hearing by hastily launched half-baked policies.

There are lots of elderly people who would benefit from a move out of a home that has become too large to maintain, too expensive to heat and too isolated from once familiar neighbours to feel safe and secure.  The drivers for a move are already there, compulsion is neither needed or helpful.

I have been privileged to be involved in building thousands of retirement houses over the years and if they provide independent living of a good standard with a degree of support, they are an attractive option for many elderly people.  The Minister needs to make positive steps not beat people with a stick.

Posted in RETIREMENT HOUSING | 1 Comment