Live longer with dementia: Mr Hunt pillories the profession. Most doctors will be making “living wills” to avoid over-zealous care and prolonged demented lives…

Sarah-Kate Templeton in The Sunday Times 6th March reports: Hunt warns doctors over poor weekend care for dementia patients (Live longer with dementia: Mr Hunt pillories the profession. Most doctors will be making “living wills” to avoid over-zealous care and prolonged demented lives… It will take another 15 years to replace the staff that are retiring or needed. Its not a good time to advocate the quality of care that many in the profession will see as “prolonging death”.) Below, Oliver Moody reports on screening for 40 year old men planned – and this may actually do harm. Putting knowledge of demographics above the psychological health of the individual…

JEREMY HUNT has thrown down the gauntlet to doctors striking over seven-day working by warning that dementia sufferers are being let down by the failure of the NHS to introduce it and are the biggest victims of poor weekend care.

Pledging an overhaul of the way dementia sufferers are treated in the NHS, the health secretary said attempts to introduce a safer seven-day service had been “a bit distorted” by the junior doctors’ strike into a debate about doctors’ terms and conditions.

Announcing plans for all dementia patients to be checked by a consultant at least once a day, seven days a week, by 2020, he told The Sunday Times: “We don’t have anything like as much focus as we need on what the impact is going to be for patients.

“Dementia is probably one of the best examples because death rates in hospital are a third higher for people with dementia and they stay in hospital 25% longer and 25% of inpatient beds are occupied by people with dementia. Although it is not just for them, they are very disproportionately impacted by having a safer seven-day NHS.”

His raft of measures include a promise that, by 2020, all dementia patients on high dependency wards will be seen and reviewed by a consultant twice a day, every day of the week.

Hunt has already pledged that, if clinically appropriate, all patients will be reviewed by a consultant once a day, every day of the week, by 2020. Hunt said being checked by a consultant daily was particularly important for dementia patients.

“People admitted to hospital should be seen by a senior doctor within 14 hours of being admitted, seven days of the week, and currently only 1 in 8 hospitals is meeting that standard,” he said.

“High dependency patients should be checked twice a day by a senior decision maker across seven days and that only happens in one in 20 hospitals. Again, often people with dementia who tend to stay longer in hospitals are going to be in that high dependency category.”

Hunt said the daily and twice daily consultant checks seven days a week would be carried out in a quarter of hospitals by March 2017 and half of trusts by March 2018.

Last month Hunt announced that he would impose a new contract for junior doctors after the breakdown of negotiations with the BMA, the doctors’ union.

Hunt claims the current contract is unfair and unaffordable in that if one doctor works just one hour over the maximum shift length it can trigger a 66% pay rise for all doctors on that rota.

Junior doctors working Saturday evenings from 5pm, nights from 9pm and any time on Sundays will receive additional pay under the new contract but these payments for working unsociable hours will be less generous than under the previous contract.

In return, junior doctors’ basic salary will be increased by 13.5%. Hunt has pledged three quarters of junior doctors will see their take-home pay rise while no junior doctor working within contracted hours will have their pay cut.

The BMA has responded with plans for three 48-hour strikes in March and April, during which junior doctors will offer emergency care only.

Under the plans to improve dementia care, the part of the NHS health check dealing with the disease will be extended to those aged 40 and older.

At the moment, the NHS health MoT only includes discussion of reducing the risk of dementia in patients aged 65 and above.

Dr Mark Porter, BMA council chairman, said: “The health secretary continues to conflate the new contract with extra seven-day services, and cynically portray junior doctors as a roadblock to his plans, when the reality is that junior doctors already work around the clock, seven days a week, and they do so under their existing contract.

“If the government wants more seven-day services then it needs more doctors, nurses and support staff, and the extra investment necessary to deliver them.”

 

An advanced directive or living will – It’s important to specify, especially lying flat. Good news if you take action.

Demographics – it seems as if rural areas are being occupied by more elderly. The implications for service delivery without rationing (overtly) are macabre.

Who will write the obituary for UK General Practice? Will you know the doctor looking after you when you die?

‘Do not resuscitate’ is doctors’ own choice for end-of-life care – but perish the thought to educate patients!

The Nursing home crisis is upon us. There is not enough space or money for everyone.
 
Dead people don’t vote… End-of-life care ‘deeply concerning’

Death discussions ‘taboo’ for many in UK, survey finds

So tell me how you want to die

40-year-olds to get dementia checks (Oliver Moody)

Patients as young as 40 will be routinely checked for early signs of dementia in a pilot scheme announced by the government yesterday.

Jeremy Hunt, the health secretary, set out plans to make Britain “the best place in the world to live well with dementia” by 2020, revealing that inspectors will judge hospitals on how they look after people with the condition.

More than 850,000 people in the UK suffer from Alzheimer’s disease and other severe neurodegenerative memory problems. The number is forecast to rise to more than one million over the next decade. Only those over the age of 65 are regularly offered the chance to discuss their risk of dementia as part of their NHS health checks, described as a “midlife MOT”.

Under the new proposals this will be extended to all adults aged between 40 and 74 in some areas. If the scheme is a success, it will be extended across England, allowing GPs to suggest ways of combating or warding off early stages of the diseases to those most at risk.

Personalised measures could include exercise, which is thought to be the best protection against dementia, as well as plans for controlling weight and blood pressure. The second part of the plan is a target for one in ten people diagnosed with dementia to take part in research into ways of better understanding and treating the condition.

Mr Hunt also denounced “unacceptable” variations in the quality of care between different areas and said that patients and their relatives would be able to draw “meaningful” comparisons for the first time. The Care Quality Commission will carry out inspections to assess standards and diagnosis rates.

Research by the Alzheimer’s Society suggests that more than nine out of ten people think hospitals are frightening places for people with dementia.

The health secretary pledged that dementia patients in high-dependency care would be seen by a consultant twice each day where it was appropriate.

“A dementia diagnosis can bring fear and heartache, but I want Britain to be the best place in the world to live well with dementia,” he said. “Last parliament, we made massive strides on diagnosis rates and research: the global race is now on to find a cure for dementia and I want the UK to win it.

 

 

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This entry was posted in A Personal View, Consultants, General Practitioners, Rationing on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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