Health Matters | Paul Corrigan's blog

Looking back over the posts on my blog the only time that I have really talked about cuts in local government services has been in the context of how lucky the NHS is to have overall funding that has not been cut.

That has been an error on my part. It is obvious that the cuts in social care would have an impact on the work of the NHS and this is starting to happen. Some parts of the country in which I work have over 120 older patients whose discharge from hospital has been blocked by social care problems. Given this is May and not December these numbers are bigger than the health care system would like and foretell bigger problems by the winter.

Yesterday saw a report drawn from Freedom of Information requests from 120 different local authorities showed that in 2011 there were 11% fewer older people that had completely free home care services than in 2009.

The average charge per hour for those having to pay the full cost has gone up by 10% over the last two years. On average older people have 10 hours of home care a week and would therefore have seen their home care bills rise to £7077 by next year.

The rise in the threshold for free care and the rise in price will inevitably mean that some older people who would have had care will not be getting it.

The point for the NHS is that the older people who would have been relying on these services are also some of the core customers of the NHS. This demographic group have to use a lot of NHS services and on occasions will be spending time in hospital with inpatient care. The decision that the hospital will make about their discharge will depend on the level of care available at home and some of that care will have gone missing. People will stay longer in hospital than they would have.

The Alzheimer’s society has the right comment.

 “Many people with dementia and their carers are already struggle to pay for home care. The extraordinary costs in some parts of the country don’t even guarantee good quality care. This is disgraceful. Home care services are vital in helping to maintain quality of life for people living with dementia”

And, they might add, will lead to increased use of hospitals as places of safety even though these are probably the most disturbing environment for people with dementia.

The real problem is that the cuts in the social care budget have only just started. There are cuts of 28% in the funding of local authorities over the coming four years.

Over that period of time the rise in demand for health care from older people is likely to be in the order of at least 10%. If, because of social care cuts in services, that 10% of new patients stay in hospital for just a little longer than current patients the NHS with a flat budget is going to be in even more trouble than we thought…

(Conservative Manifesto 2010)

It was always going to be interesting to see how the Coalition government would live with this pledge.

Over the last weekend, just prior to its conference, the Royal College of Nurses published a survey of its members reflecting their experience of patient waits in A and E. Their President was on the airwaves saying that the progress that had been made on speedier and better working with A and E patients was being lost as more were being treated on trolleys. Read the rest of this entry »

Regular readers will remember that back in April 2011 the Government paused the development of its health policy and outsourced it to a group of people it brought together over a weekend. At about the same time number 10 let it be known that the Prime Minister had made a strategic error when he came into power eleven months earlier, in explaining how he as Prime Minister would lead the organisation of the Government. Read the rest of this entry »

I received some interesting comments on last week’s posts about the necessity for investment in improving self-care to improve value for the NHS. Most of my posts concerned the implications of some recent work on diabetes and also articles in the Lancet from last Friday on co-morbidities in Scotland. Read the rest of this entry »

Having set out the general case for moving away from the old fashioned idea that value in health care can only be found by buying more medical staff, kit or drugs, I have suggested that investment in patient health literacy would increase the value they contribute to their own care. This would, as a consequence,  add value to the NHS as a whole and help change its resource base at this time of austerity. Read the rest of this entry »

Why doesn’t it just happen anyway?

To rehearse the argument so far. Given that the percentage of GDP spent on the NHS will not rise very fast and the demand for health care will, those of us that want to save the NHS will have to help it find new sources of value to develop significantly more health care outcomes from the same resource. Read the rest of this entry »

The moral arguments in favour of greater self-care within the NHS have been around for some time. I have myself been involved in them for over 30 years. Therefore some of the counter arguments against co-produced health care have been trailed and discussed for some time. Read the rest of this entry »

Last week I posted twice about the importance of working towards health ‘outcomes’ in the NHS. The first discussed the difference between inputs, outputs and outcomes; the second drew on the excellent work of the Richmond group of patient organisations in using outcome measurement in creating much more patient-centred healthcare. Read the rest of this entry »

I remember, in the autumn of 2010, writing about an important paper produced by 10 major patient groups and suggesting that perhaps this would prove to be a more important document than anything else that was going on at the time with regard to the wrangling about the Health and Social Care Bill. Read the rest of this entry »

No 1 Working towards improving health care outcomes

We are now a few weeks on from the passage of the Act. The glimpses of the direction of its implementation that we have had since then are as contradictory as the Bill itself. The Secretary of State writes to the NCB saying that they must ensure that there is autonomy for CCGs and the Chair of the NCB responds by saying that it will be some time before the NHS will be liberated from its centre. Read the rest of this entry »