Does the Dame feel that doctors are not trained in care of the dying? GP training used to include this as a key part of the curriculum, and most people should be able to be cared for by their GP practice. Unfortunately, the new contract and loss of 24 hour responsibility, has led to less continuity of care, and in effect made “palliative continuity” a voluntary service provided by a few…. Hospice doctors offer no more “continuous care” and their funding is only partial, but they are less distracted by other demands.. Perhaps the “Hospice at home” is the most cost effective and for many of us the most desirable, but the population at large needs to be educated to this effect, and perhaps there need to be incentives to help families keep patients at home, and employers need to be helped to facilitate this.. Traditional In-patient Hospices are not viable in small populations
All doctors and nurses would be trained in end-of-life pain relief and how to discuss death openly and sensitively with their patients under a bill to be presented in the House of Lords today.
The Palliative Care Bill would also make it a failure of duty of care if appropriate pain relief were not given in the final stages of life.
The bill has been tabled by Baroness Finlay of Llandaff, a professor of palliative care who came ninth in the peers’ ballot for private members bills.
She has been campaigning for better palliative care for many years and said the recent health service ombudsman’s report into end-of-life care showed that not enough had been done to address the problem.
Communication between health professionals and patients was an important starting point, she said. “Now that we can treat so much there is a kind of unrealistic expectation of us being in control . . . We need to get talking about the end of our days.”
The ombudsman found that hundreds of thousands of people were at risk of a painful, undignified or lonely death because of poor end-of-life care right across the health service. Among many problems, it singled out poor communication, citing examples of patients not even being told they were dying but finding out from their notes.
A spokesman for the Department of Health called the findings appalling and suggested that ministers might back the bill.
It beggars belief. Who commissioned the report? What were the questions and how much bias was there in both the questions and the questioned? Yes, some targeted areas do very well, but access to A&E and GP services is dreadful, and there is chronic undercapacity. Politicians have ignored the long term investment needed – a natural weakness in our political system. The Regional Health Services, especially in rural areas are imploding. You may feel happy with the NHS if you have never used it. You certainly cannot complain if you are dead.. Without a New Zealand style approach to honest and overt rationing, and especially if Health and Social Services are combined, there will be an increase in covert rationing – mainly directed at the elderly, mentally ill, and inarticulate.
John Appleby points out “… support for the NHS might be rising as health climbed up the political agenda rather than because care was improving markedly…. As well as an actual increase in satisfaction, this may in part reflect a desire among the public to show support for the NHS as an institution.” Read the whole article – Voters are happier than ever with NHS
The GP partnership model will disappear in a decade and primary care will be provided by organisations the size of CCGs, according to the deputy medical director of NHS England.
I would agree with Mike, and furthermore, I would say that in future the “real doctor” in the community will be one who maintains his emergency skills, is able to manage Out of Hours, and at the same time is involved in teaching and end-of-life care. Such individuals will be really valuable, especially now that successive government administrations have rationed the number of doctors in training so that we need to import for the next decade..
Dr Mike Bewick, a former GP in West Cumbria, said the combination of a growing shortage of GPs and the changing needs of patients and local populations, would require a major restructuring of primary care.
The advent of co-commissioning by CCGs, and the need to provide services ‘at scale’, meant it was now ‘squeaky bum time’, he told a Westminster Health Forum conference in London.
‘This is the time when we actually have to say what we are going to do. And I am going to say just two things that I think are going to be true.
‘One is that in 10 years’ time the term independent contractor will be anachronistic and probably it will be gone.
‘And the second is that we will not talk about primary care, we will talk about out-of-hospital provision and out-of-hospital providers.’
GP shortage damaging partnerships
He said the lack of new GPs being trained meant that ‘we are going to lose doctors from the frontline very, very quickly’, and this would impact on the partnership model of general practice.
‘If you look at primary care, more than 50% of the doctors are salaried. There will be a force majeure to move away from a partnership type organisation because it will not serve them. And equally if you cannot recruit to partnerships you will need to think of something different.’
Dr Bewick said that ‘organisational nihilism’ in the NHS was preventing the system developing to meet changing priorities.
Primary care unsustainable
‘I do not believe that the current organisational structure of primary care is sustainable or, increasingly, desirable.
‘I do believe that in the end, the whole of the out-of-hospital service needs to come together to form a more integrated service.’
He expected new provider organisations to develop, each covering populations of about 300,000 – the average size of a CCG. ‘The provider at scale is in the six figures. It is not in four or five figures.’
Pharmacists and other healthcare professionals would be better utilised to fill the gaps left by GP recruitment problems.
But the move to large-scale primary care provider organisations would not mean the loss of local, personal healthcare services, said Dr Bewick.
‘I do not think we should be confusing that with not delivering healthcare by people you know in your locality. Localism is in my blood.
‘We should be forming organisational mergers with either community trusts or secondary care, or with other providers from other sectors. Providing they have the values of the NHS at their heart, I am not too worried about who delivers but more how it’s delivered and the outcomes for patients.’
Where health is concerned we often get what we deserve both as families and as individuals. If people are not prepared to plan they will have a prolonged death, and more death duties…. Should there be a reward for making and registering an advanced directive?
Discussing dying and making end of life plans remain taboo for many people across the UK, a survey suggests.
The poll of 2,000 adults for the Dying Matters Coalition of care organisations indicates that only 21% of people have discussed their end of life wishes.
Only a third said they had written a will and just 29% had let loved ones know of their funeral wishes.
The findings are being released at the start of the Dying Matters Coalition’s annual awareness initiative.
The coalition was set up by the National Council for Palliative Care in 2009.
The chief executive of both organisations, Claire Henry, said: “Dying is one of life’s few certainties, but many of us appear to be avoiding discussing it or in denial altogether.
“Talking more openly about dying and planning ahead is in everyone’s interests.”
‘Fear of the unknown’
The survey also suggests about four fifths of the public believe people are uncomfortable discussing dying and death.
And 51% of respondents said they had not made their partner aware of their end of life wishes….
There are new drugs for Malignant Melanoma (MM), and if you get the diagnosis early, the result can be favourable. However, MM is still the diagnosis I would least like to have. The new interactive map (The environment and health atlas of England and Wales) shows the increase in incidence around the country. It does not show prevalence, which would include those who are alive with the disease…. The good news is that “Gene Therapy” is making great but expensive advances in this area. The bad news is that, in the crisis to come, your region may not be able to afford the treatments for everyone, and especially if you are elderly. You may need to be assertive, or to game the system to get choice, (Move between regions) in order to get the best care.
The Post Code lottery at it’s worst?
Almost by sleight of hand, and over some years, elderly care in Nursing & Residential Homes has been taken out of the state and become private. The state controls the payments to nursing home owners (because most residents do not have the means), which means owners are having great difficulties covering their overheads, let alone making a profit. They are mostly privately run enterprises, but are sometimes owned by listed companies. Southern Cross (2011) was one of these… and has gone bust. It is not surprising that families try to plan their affairs so that estates are at or around the threshold for means testing at death. The incentives are to avoid or reduce payments, and if this is unplanned/unexpected then avoidance amounts to “fraud”, but if it is planned well in advance, and assets are given away well before death, then it becomes acceptable. Financial advisers call death duties the “voluntary tax”, which is paid more by those who fail to plan ahead… and nursing home contributions appear to be becoming a similar thing..
The Audit Commission recorded an 82 per cent rise in the amount lost to councils last year as families avoided nursing-home fees, pocketed money destined for home-care services for elderly relatives, or failed to report the death of a loved-one to keep receiving payments of up to £60,000 a year.
The commission, which monitors fraud across councils, said that government policies and the ageing population had led to scams costing taxpayers tens of millions of pounds a year.
Anyone with savings over £23,000 has to pay for residential care, which can cost £200,000 a year, until their assets fall below that threshold. Some families are trying to hide their savings by transferring money out of their accounts, while others are falling foul of arcane rules when the transfers are legitimate……
“Wales could become the first UK nation to have an independent watchdog with the power to stop the publication of some of its reports and to prosecute those who go against its wishes.
Public Servicers Ombudsman Peter Tyndall wants more confidentially powers to protect vulnerable people.
It would mean complainants could face contempt of court charges if they go to the media.
But some warn it would mean less transparency.
Mr Tyndall has legal powers to review complaints about public services such as hospitals or councils in Wales…..”
So once this is law, the people of Wales won’t necessarily know what is going wrong! It will affect us all. The differences will have to be explained to them from outside Wales, in the same way broadcasting uses propaganda to undermine Middle Eastern despotic regimes, and inform its people of the truth! Not much chance of public confidence in stopping gagging, reducing post-code rationing, encourage commissioning for quality, and provides an immediate perverse incentive not to correct problems.