MISSION-ROOM 41

The deep coloured greenery swelled out and spilled over the top of the plastic carrier bag, which had been handed to me. Hidden beneath the massive aromatic foliage were more interesting items. There were three Pak Choi and one splendid white Mooli.   It was lunchtime when I made my visit to the care home, carrying this abundantly overflowing bag.  In my spare hand I held a pack of raspberries, a treat.  I got curious looks from the care staff and some polite smiles.   I was on a visiting mission. I knocked on the door of room 41.

© Elegant Veg

She immediately wanted to know what I was carrying. I got her to feel through the foliage and the thin stalks. Still not sure, I encouraged her to nibble at a little of a leaf. Yes, it tasted of something but what?  She sniffed the green bunch and stroked the stalks.  Realisation; her mother used to grow this and use it in soups, make soup with it and put it with meat and gravy.  She couldn’t remember how long ago, but it made for a good flavour.   Did the Mooli have a sharp and hot radish flavour, she wanted to know and could it be boiled or steamed.  What about the other one, the Pak Choi?  She was thinking and asking questions while I gave my ideas for preparing the two vegetables.

© Our Yellow Beetroot.  Pak Choi it is not.

We shared savoury and sweet  recipe ideas  for the best part of an hour, and the time passed pleasantly and quickly. The raspberries, which all got eaten, evoked thoughts of home made cakes; puddings; jam; outings with an enamel bucket used for collecting and cooking the raspberries, in times long past.

On my way out, staff asked me about the greenery I was carrying.  One, a Bulgarian lady did not know Pak Choi, but bemoaned the fate of her garden back home without her.  A local carer had no idea about any of it.  A Chinese carer squealed with delight when she saw the Mooli and was thrilled to hear we called the other little vegetable (the Pak Choi) the same name she knew it by.

 

Advertisements

CARE IN THE COMMUNITY – LET’S TALK.

The deaths of a number patients in the community led to fatal accident enquiries,(FAI’s) during which a number of community physicians were cross-examined about their practice abilities and patient care. These enquiries are similar to those of the Coroners’ Courts in England and Wales.

The clear message that came out of the FAI’s was, the communications between hospital specialists and the community physicians was totally unfit for purpose. The term ‘woefully inadequate’ would have been too gentle a criticism of the virtual blank wall between hospital knowledge and the absolute patient requirements for effective care in the community. The standard discharge from hospital letter that followed a patient’s movements, was inadequate and it relied, in the majority of cases, on someone handing this outline letter to a GP practice reception. G.P’s had difficulties contacting specialists and obtaining information. It was a sorry state of affairs.

Sadly, the patients who died had special medical needs or rare conditions understood in some depth by specialists and not by general practitioners. Some of the consultants would have been based in the regional hospital and others would have been out of region. They offered follow-up out-patient services in the regional hospital. This system still pertains. GP’s started to tell patients with special needs that the hospitals, sometimes hundreds of miles away, had to continue their care, they, the GP’s could not. Since the FAI’s and the GP ‘work to rule’, there have been practice changes. There has been a major overhaul of information technology and consultants are more readily accessible to the G.P’s, BUT, only within region.

The General Practitioners can now obtain reports of consultations and diagnoses, also the medical care required, all at the press of a computer button. This arrangement does rely on the individual uploading the information and doing it promptly at the hospital end. Blips occur, though in my limited experience, they have been rectified relatively quickly, once noticed.

Likewise, and this relies on good practice pertaining within hospitals, essential community G.P. practice information about a patient can be accessed through the I.T network, for example, about drugs intolerances.

It is a big improvement on what happened in the past and the technology can work. The I.T. systems seem to be up to the job. The weaknesses though, are obvious, the system is not infallible, but then nothing is. The access to information is dependent on timely recording onto the computer systems; it is dependent on hospital staff seeking community information and also checking on in-patient medical history, all being good medical practice.

One of the largest weaknesses is that the sharing of vital information is limited to the hospitals and community medical practices based in the regional health authority. A major communications gap exists, fraught with old dangers because a range of specialist expertise is based outside the health authority.

The regional I.T. system is, to a large extent, doing what it was set up to perform, to share important health care patient information, so community health care professionals in theory, can provide appropriate care in the community. I say in theory, because the other major weakness lies in what resources are available to continue supporting specialised care requirements in the community.

NOT FORENSIC DENTISTRY AGAIN!

Continuing the dental theme of my last post.

Dentist’s are so good at ‘training’ people who probably have had all sorts of advice and guidance over years, much of it changing with time, some of it conflicting and a lot of it the same.

I moved from manual brushing to an electric/battery brush a number of years ago. It was my momentous change of oral hygiene habit. Apart from that,at this stage of my teething life, hearing all about my surmised dental behavioural history, obtained from the ‘clues’ in my mouth, every time I saw a dentist, became an exercise in being polite and switching off. It felt like it was an exercise in blaming the patient for requiring a dental examination appointment. A dental experience is not something to look forward to, being belittled on top of it, is just beyond the pale. If I were a junior, or in my early teens, there would be some merit to detailed ‘lecturing’ on how to practice daily hygiene, what to avoid doing and why.

Trying to keep up with dental checks when there was no dental practice for hundreds of miles has been an issue for thousands of people. Since a service has appeared that is within more reasonable travelling distance, the problem has become one of obtaining appointments.

There is a temptation to point out that preventative dentistry in my youth was not even on the horizon, neither was fluoride. Preventative dentistry was having all your teeth extracted for reasons that would be considered extreme today. Dental medicine, knowledge and practice, has developed out of all recognition. What there is in my mouth today, there is; none of it is, fortunately, truly awful. I know this, and my latest visit to a different dental practice and dentist, confirmed it. It was also refreshing to talk to a dentist who accepts what there is, confirms that my teeth are quite good and who says that my oral hygiene is fine.

WHO SAID THE FIRST CUT IS THE DEEPEST…..

A long time ago I posted about various social issues. One of them was the so-called free personal care in Scotland. A few people spelt out the truth of the myth. It did not suit either the media or politicians of various persuasions to examine the truth of the matter.

Scottish elderly and other vulnerable people, who needed residential care, had certain benefits removed, that their counterparts in the rest of the British Isles were able to keep. By this clawback, there was already a major chunk of contribution being paid to that mythical free care. We worked out that a relative was left with a really tiny sum of benefits from allowances that other British people retained. We did not complain or moan about inequities; we did complain about the iniquity of the claim that there was free personal care.

Various social care organisations and charities now spell out the dreadful scenarios for the elderly and vulnerable individuals of all age groups in the community. Local authorities, who have severely restricted budgets will no longer be able to provide home-help, and arrange for such invaluable support like respite care for carers, (if any is left). The worrying picture painted, is likely to be so. There have been Limitations of service by changing the definition of what constitutes ‘severe or critical need’ for a long time. It is more commonly known as moving the goal posts. Re-defining needs is likely to be played with much more.

Home help provision where I live, used to be means tested help. If you were over a certain low income level, you contributed to the cost of the service. That was generally accepted, until the calculation of the contribution changed to a vastly increased fixed hourly rate, irrespective of the individual’s circumstances. The local authority service provision was in this manner, priced out of the pockets of those who needed it. It became more affordable to seek home help support from private sources, if you could find it.

In urban areas, agencies sprung up under contract to social service departments. This was economic outsourcing. Their service levels and quality of work were of concern. The same applied to care homes, whose services had mushroomed as private enterprise, since the 1980’s.

To counter the worrying standards of care, Care Commissions were set up in recent years, to inspect and regulate standards of practice training and qualification. They were always an imperfect tool, but their existence was preferable to not having any standards to work to. Their budgets are slashed too.

As a humane nation, we did get used to knowing that the vulnerable in our society would be cared for. We are uncomfortable with the growing truth that this is unlikely to continue to be so.

JOINED UP WORKING

Slowly but surely, the hindsight investigation in to the death of a toddler is treading its way through a variety of professional enquiry systems. It strikes me, the disparate enquiries reflect the untidy mass of systems that have not, to date, worked in any coherent way with one another.

My belief is, that until there is serious joined up communication, a trust between the organisations and professionals, to enable them to work supportively with one another, child killing cases in the UK, such as the ones of Maria Colwell, Victoria Climbie, and Baby Peter, will continue to appear.

In times of austerity,tougher times that will cause increased individual and family pressures, where a timely intervention could be a lifesaver, it is going to become even more imperative that services do develop broader interdisciplinary teamwork skills, outside their offices, clinics, surgeries and hospital wards. Egos have to be left at the door!

Quality training and dedicated skilled leadership will go some way to improving community protection services for vulnerable individuals. These and the other service structures mentioned above, on their own will not. I know that recent practice and regulation manuals spell out what I have always believed; (better now than not at all). My concern is that Staff shortages, increased workloads for those who are left in the field, will dilute efficacy for practice developments that are still very much in their infancy.

AT LEAST WE HAVE IT.

Last week, a cousin living in America, came home to help his eighty year old mother settle into her new, more suitable and smaller accommodation. His mother is severely disabled with kidney failure and heart problems. Although we have little community and medical support for the needs of such patients in our community, his mum does obtain highly technical equipment to use at home, (even if has failed four times in a year) and the medications that she needs, to live a reasonable quality of life.

There are people all over the world who just would not survive major organ failures, as services and equipment are not available, or, at any rate, it would not be, without heavy costs.

Our cousin was describing the increasing visibility of the unemployed, in what has been a reasonably prosperous area till recession struck. The people receive food vouchers for specific kinds of food shopping. The check-out queues, these days, are more usually populated by voucher holders than people who have the ability to purchase their household shopping.

While welfare, such as it is, in America, has recently been extended beyond previous time limits, those without jobs or regular income, have no medical cover, no eye care, or dentistry. There will be some limited service at emergency level (Accident and Emergency). Ongoing needs will be neglected because of a lack of insurance or money.

America is a commodity society in all areas; commodities have to be purchased. It includes a whole range of life-saving, quality of living, and basic health care elements, that we are fortunate enough to be able to take not ‘for’, but, as granted. Sure, those of us in work, pay a national insurance contribution that is meant to cover what we receive. At times, it may be a highly imperfect health care system, but, at least we do have it.

MISSION – ROOM 41

The deep coloured greenery swelled out and spilled over the top of the plastic carrier bag, which had been handed to me. Hidden beneath the massive aromatic foliage were more interesting items. There were three Pak Choi and one splendid white Mooli.   It was lunchtime when I made my visit to the care home, carrying this abundantly overflowing bag.  In my spare hand I held a pack of raspberries, a treat.  I got curious looks from the care staff and some polite smiles.   I was on a visiting mission. I knocked on the door of room 41.

© Elegant Veg

She immediately wanted to know what I was carrying. I got her to feel through the foliage and the thin stalks. Still not sure, I encouraged her to nibble at a little of a leaf. Yes, it tasted of something but what?  She sniffed the green bunch and stroked the stalks.  Realisation; her mother used to grow this and use it in soups, make soup with it and put it with meat and gravy.  She couldn’t remember how long ago, but it made for a good flavour.   Did the Mooli have a sharp and hot radish flavour, she wanted to know and could it be boiled or steamed.  What about the other one, the Pak Choi?  She was thinking and asking questions while I gave my ideas for preparing the two vegetables.

© Our Yellow Beetroot.  Pak Choi it is not.

We shared savoury and sweet   recipe ideas  for the best part of an hour, and the time passed pleasantly and quickly. The raspberries, which all got eaten, evoked thoughts of home made cakes; puddings; jam; outings with an enamel bucket used for collecting and cooking the raspberries, in times long past.

On my way out, staff asked me about the greenery I was carrying.  One, a Bulgarian lady did not know Pak Choi, but bemoaned the fate of her garden back home without her.  A local carer had no idea about any of it.  A Chinese carer squealed with delight when she saw the Mooli and was thrilled to hear we called the other little vegetable (the Pak Choi) the same name she knew it by.

 

CARE FOR THE ELDERLY – FREE?!

Residential care for the elderly is being featured for a month on BBC Radio 4. There are so many aspects to it that I wonder what the overall focus will be. One major concern is the cost of care and how it should be met.

Like many, I have been directly involved in arranging care for an elderly relative and being supportive to a family member who had to deal with similar issues. One is in Scotland and one is in England. Finance is a major concern.

I live in Scotland. It is being touted that personal care for the elderly is free. It is not. There is some assistance with it, but it is not free. Like everywhere else, care is means tested. Let’s consider some of the arrangements that pertain in Scotland, England and Wales.

Scotland; if personal care is claimed, there are two levels. To get the second and higher amount of £175 per week, the condition of the person needing care, has to be what should be a total hospital care responsibility and you have to prove your claim. The lower level, more commonly paid is, £145 per week.

In England, the point above compares with trying to obtain nursing fees; it is a battle to get anyone to agree the condition of an individual requiring that level of care as the local NHS Trusts do not want to pay the costs.

Again, in England, if the resident is self-funding, the Attendance allowance is kept. If not, the Attendance Allowance is paid to the residential or nursing home.

I have not yet researched the above point with the Welsh experience.

However, when a claim in made in Scotland for the personal care allowances, at whichever level, the first thing that disappears is the attendance allowance, assuming that the benefit has been received. The higher level attendance allowance is about £62. That is a financial off-set for the government against a personal care allowance for someone in residential care. Therefore, £145 less £62 = approx £83 per week. It is just £20 or so, higher than the attendance allowance.

I have no objection to sacrificing the attendance allowance, but it should be remembered it is an offset against the allowance, rather like a tax deduction and leaves a cash benefit of approximately £20 per week extra. The savings allowance threshold will further off-set that sum for the government, (see below).

The financial off-sets do not stop there. The maximum savings threshold a Scot may hold from which no further deductions are accounted against, is £20,000. In England the savings threshold is £22,000 (when I last looked at the figures); in Wales, the savings threshold is £23,000.

Savings Allowed

England £22,000 Wales £23,000 Scotland £20,000

There are no plans to increase the savings threshold for the Scots, even though the question has been raised in the Scottish Parliament.

I leave you to figure out what ‘free personal care means’.

PROVING THE OBVIOUS

According to research we in the U.K. are;

1.Below the level of eastern block countries for our cancer survival rates;

2.There are inherent dangers in cardiac patients and people with other
chest/breathing difficulties being transported distances to obtain appropriate medical care;

3.And if you live in North London, where patients have to be transported through dense London traffic up to TWELVE MILES to have heart and breathing problems dealt with, you are likely to have even weaker survival chances. Even weaker than what? Someone who has to travel hundreds of miles for similar treatments?

Analysis:

Okay, we are keenly aware as consumers that our medical services can be well below first world country standards. If you live, as I do, in a remote area such lacks are even more pronounced.

Transporting of patients over huge distances is a perennial requirement here; when available (note ‘when‘)helicopters have to transport severe life-threatening cases to not one hospital but two, sometimes even, three. Often the first is a triage and holding station, the second is another triage and specialist assessment and the third is the one where the specialised resources reside, if all that is needed doesn’t exist at hospital number two. Two hops can be made if it is clear from the outset what services are needed that do not exist in the region. The examining doctor needs to be familiar with regional resources The distances covered are about 300 miles, if within Scotland.

For the very infirm, limited ambulance transport just might be available either for county out-patients’ requirements (40 miles round trip) or regional ones 240 miles round trip. Otherwise, you may be fortunate to be squeezed into a taxi with several other frail people, to meet up with a hospital service minibus 50 miles down the road. For other ambulance needs, perhaps a maternity emergency that can only be dealt with at regional HQ, an ambulance would have to be found and a midwife organised, this, sometimes with difficulty.

I have absolutely no sympathy with twelve miles for a North London Hospital, I heard bemoaning the problem in its own terms this morning. This is a hospital I became extremely familiar with last year. A filthier, dirtier medical establishment in the U.K. I have yet to see. It is no wonder Chase Farm Hospital near Enfield is a failing hospital. In my view, it would be safer, if any of our hospitals can be construed as safe, to go elsewhere, even if it is three or four miles further on.

The variables used in the research models would be worth a quick look just so we could say “I could have told you so, without the expense of research”. However, in days when everything we query has to have evidence to back it up, such basic facts have to be ‘researched’ to point out the obvious.

PARING BACK TO THE BONE

“We have been told from on high that we are not to take any new cases onto the books unless they are critical.” This is care in the community today.

There are rules that require the caring services to liaise, formulate care plans that involve all relevant agencies and at the head of each case plan there should be a leader. The leader can be for example, a nurse, a health visitor or social worker though if medical requirements are involved close liaison with a community doctor is paramount. That carefully formalised commonsense idea gets blown out of the window when one or more of the agencies concerned is unable to function because of orders from on high. It is a high risk strategy, a recipe for courting high profile complaint as the least worst scenario or at the other end of the scale, a disaster, which, no doubt, would highlight the impossibility of meeting statutory community care regulation and requirements on contrained budgets. It is stark rationing.

In an area where provision in all quarters rose from nothing in twenty years to the bare minimum that it can get away with without breaching U.K. Law and human rights, there is nothing to pare back to but bone.