'NHS must cut beds for better care' - Chief Nurse

THE NHS should spend more money looking after patients in their own homes instead of paying for hospital beds, the country's chief nursing officer warns today.

Jane Cummings, chief nursing officer at NHS England, said patients were being denied care at home because too much cash was devoted to paying for "old and expensive buildings".

Writing in The Daily Telegraph, she said the absence of adequate home care was trapping people in extended hospital stays which made them more ill.

She also called on health bosses to use a round of regional reorganisations to shake up "outdated" care methods and prevent patients "falling into the cracks" between different parts of the system.

She acknowledged, however, that refocusing the health service would be "controversial". The NHS is battling record levels of bed-blocking in hospitals due to the crisis in elderly care, which regulators have said has reached a "tipping point" because of the closure of residential homes and shortage of domestic carers.

Delays in the transfer of care are estimated to cost the health service around £900 million a year, with the cost of keeping an elderly person in hospital for a week about £3,000.

"With more care provided at home, the NHS can spend more cash on patients rather than maintaining old and expensive buildings," she said.

"More people can be better looked after with care personalised to their needs," she added.

On a local level, she said, the NHS "wants to invest in home-based care, but it struggles because resources are currently tied up in hospital beds".

Hospitals and other providers in England overspent by at least £2.45 billion in the last financial year, prompting the NHS to divide the country into 44 areas, ordering local managers and councils to come up with restructuring plans to improve efficiency.

A number of the schemes, called "Sustainability and Transformation Plans", have been criticised as heralding closures of A&E units and cuts to hospital beds.

But Prof Cummings said the restructurings provide a chance to make services smarter.

"As life expectancy increases, so do the ailments of old age and there are now more people with chronic conditions like heart failure and arthritis," she said.

"There are also big opportunities to improve care by making commonsense changes to how the NHS historically works, improvements that matter like making it easier to see a GP, speeding up cancer diagnosis and offering help faster to people with mental ill health."

Other commentators, however, have noted that the crisis in social care and the resulting bed blocking will only be solved if a significant chunk of the NHS budget, which is around £126 billion, is transferred to the £17 billion social care pot, which is administered by local authorities.

The chief nursing officer said that, as well as enabling more patients to be treated at home, restructuring should embrace smaller numbers of specialist centres, where appropriately trained staff are "available round the clock".

She cited stroke services in London, where the number of stroke wards was controversially reduced in favour of a small handful of "hyper-acute" units, which the NHS claims has saved the lives of 100 patients a year.

Proposals for each part of the country have now been made and are being scrutinised by NHS executives. They involve a £30 million scheme in Surrey to take pressure off hospitals by giving people more access to GPs. In south-east London, plans involve a scheme for 16,000 extra radiotherapy appointments and 4,600 more chemotherapy treatments a year from early 2017.

"While there will always be debate about how much money the nation invests in the NHS and social care, that does not change our responsibility to patients, which is to squeeze the maximum value from every penny available," said Prof Cummings.

The head of the King's Fund think tank, Prof Chris Ham, said treatment at home was the "right thing to do" but needed greater overall spending.

"It's been part of the conventional wisdom in the NHS for some time now," he said. "But it will need investment outside hospital services - GPs, social care, district nurses - before you can realistically cut back on hospital beds.

"At the moment we know hospitals are running very hot at capacity and over capacity and the only way we can help that is to stop people turning up.

"That requires money on staff. [Now] it's all going on deficit reduction."

SOURCE: Telegraph, Henry Bodkin

Dementia patients 'get second class healthcare': Warning sufferers are given poor treatment for other illnesses because of the 'stigma' around the condition

Dementia patients are often condemned to poor care for other illnesses, doctors warned last night.

They said the ‘stigma’ around the condition meant they were given less attention than patients who were similarly ill.

They also said sufferers in their 90s or older were likely to be written off when they could receive treatment.

An estimated 850,000 people in the UK suffer from Alzheimer's and other forms of dementia

Charities said the warnings – issued at the Dementias 2017 conference – showed the need for fair treatment. ‘People with dementia have a right to equal access to treatment, support and care irrespective of their condition,’ said Rachel Thompson of Dementia UK.

‘Dementia affects everyone – the person with the condition and their family and friends. It is critical that the correct support and care systems are in place to ensure the well-being of everyone involved.’

The conference – held last week at the Royal College of GPs in London – was told dementia patients and their families were too often sidelined.

Dr Liz Sampson, a palliative care specialist at University College London, told the conference about an 80-year-old woman she saw last Tuesday.

She had a tumour that produced similar symptoms to Alzheimer’s but was offered much better care than would have been offered to a dementia patient.

‘What struck me was the cornucopia of services that were available to her and her family,’ she said.

Elderly patients are often diagnosed with dementia without other options being considered

‘She was bed-bound, she was doubly incontinent, agitated – her presentation was 99 per cent similar to the people that I see with advanced dementia. So we manage to provide care when there’s a diagnosis of a brain tumour, yet the prognosis is the same as someone in the advanced stages of dementia.’

Jonathan Waite, a consultant in old age psychiatry from Nottingham, said he felt the NHS prioritised the care of younger people. He said: ‘I’m really concerned about the ageism inherent in the whole process.’

Speaking afterwards, he added: ‘Older people have been contributing to the system their whole lives yet we seem to prioritise resources on the young.’ He warned that many older people who appeared to have dementia could have a simple short-term condition such as delirium instead.

One NHS consultant said that healthcare prioritizes resources on the young despite older people 'contributing to the system their whole lives'

He said confused patients in their 90s were often diagnosed with dementia without other options being considered properly.

Another doctor, who did not give her name, admitted colleagues tended to make less effort with elderly patients as soon as they realised they had dementia.

‘Sometimes, even if I think someone who is 95 has Alzheimer’s disease, I might not diagnose it because I know it will be a negative stigma for the patient,’ she said.

‘It won’t be in the patient’s best interests to have the diagnosis because once they have that diagnosis we won’t care about their physical health as much. It’s a very serious thing because in a hospital a doctor will say: “The patient is 94, has dementia – OK we don’t care as much about his physical health”.’

Speaking at last week’s conference, Dr Peter Bagshaw, a GP from South Gloucestershire, said: ‘The thought of missing a preventable diagnosis is the thing that keeps me awake at night.’

Alzheimer’s and other forms of dementia affect around 850,000 people in the UK with the figures expected to reach two million by 2051 as the population ages.

 SOURCE: Rosie Taylor, Daily Mail

Music provides best medicine in dementia care

A VETERANS care home has been awarded a grant to bring meaningful music to dementia patients.

Erskine were given the cash boost from the Armed Forces Covenant Fund for the six month pilot project ‘Playlist for Life’ within Erskine Park Home.

‘Playlist for Life’ works to bring benefits of personally meaningful music in dementia care to as many people as possible, regardless of where they are in the UK.

The project was founded by Scottish broadcaster and writer Sally Magnusson.

Sally visited Erskine Park Home on Wednesday to talk about the effect the project will have on those living with dementia and met with staff, residents and their families at the Relatives Cafe.

She said: “I am thrilled that the wonderful Erskine Park Home is implementing Playlist for Life.   “Personal music is such a fantastic way of reconnecting people living with dementia with their loved ones and their memories, and in many cases to lost identity.   “I am delighted to know that Playlist for Life is now going to be implemented in Erskine Park Home.

“Families will be helping staff to find the music that means the most to the resident.

“The more personal it is the more it is going to be beneficial.   “This is a joint enterprise with your wonderful staff and yourself.   “The Care Inspectorate has suggested every care home in Scotland implement Playlist for Life and I am delighted to see the message spreading which can make a real change to people’s lives.

“I wish you all the best in the Playlist for Life journey – there is going to be lots of singing and dancing!”

The broadcaster previously cared for her mother with dementia and has spoken of how she noticed that music became the only thing keeping her with the family.

She noted that music became the only thing keeping her with the family and became a tool to help her mother live with the illness. The project encourages families and caregivers to create a playlist of personally meaningful music on an iPod for people with dementia.

Researchers have highlighted the potential for music to alleviate dementia symptoms such as anxiety and agitation, reducing the need for medication.

Erskine Park Home is a 40-bed care home which offers specialist dementia care to residents who are veteran or spouses of veterans.

SOURCE: Evening Times, Holly Lennon

Dance, music and drama boost care home residents' memories

Musical activities have been shown to improve the cognitive abilities and memory recall of people living at 17 care homes run by the Anchor Group.

A series of creative workshops held at Anchor care homes in Surrey, have revealed how the innovative adoption of dance, drama and music in care home activities can soothe and stimulate at the same time, bring back memories from the past and help to engage underused but still active areas of the brain.

The care home workshops, part of a six-month trial, funded by the older people’s charity Beth Johnson Foundation (BJF), reveals a number of benefits for people living with dementia. Staff saw the sessions boost residents’ mental health, self-esteem and self-confidence, after they started getting involved in drama, dance and music.

Based on the trial’s findings, a report ‘Experiences of Being’ was published by Anchor recommending the use of drama, music and dance in care homes to help those living with dementia.

Colin Hann, executive chair of BJF said: "Dementia is an area for more work and creative thinking and this report shows how the arts and drama can make an important positive contribution to those who have dementia...in the longer term let’s also work to find a cure."

For six months, Anchor trialled the integration of drama, music and dance workshops into its dementia care, which was attended by 200 care home residents. The sessions saw positive changes in residents, many of whom experienced greater movement and physical exercise through the encouragement of dance or subtle actions using their hands or feet.

In one session, while music played, a mixture of scarves, hats, over-sized glasses, wooden spoons and maracas were given to residents to try on, prompting conversations among residents and some role play.

The report stated: 'The props acted as stimuli for the residents, with powerful and diverse reactions. The session ended with a ‘goodbye’ song, during which the props were collected and each resident was given a ribbon to wave or use in any way they choose to signify goodbye and thanks.'

One 96-year-old resident with dementia had never joined in with her care home's activities but spent all day in her room, even eating her meals there alone. She attended a weekly one-to-one prop box activity, using boxes of beads, pictures and other small items and engaged in gentle hand movements set to music.

After attending, staff noticed the resident was enjoying the sessions and “now has animated conversations about her life when she was young – memories triggered by the items in the prop box.” The staff said the workshop has improved her confidence and self-esteem and breaks down the monotony of her day.

The One-hour workshop sessions were followed by a feedback and training session for staff at the care homes who gave their own input into how they thought the sessions could be modified.

The success of the sessions has seen participating care homes introduce the workshops to the activities programme.

Anchor and BJF hope the results of the 'Experiences of Being' report will encourage everyone working with older people across the UK to consider the innovative use of arts-based activities in the homes of those living with dementia.

Jane Ashcroft, chief executive of Anchor, a not-for-profit care provider, said: “We’re keen to embrace innovative ways to enhance the lives of our residents and, with such positive results, this project has been a pleasure to be part of. I hope others learn from the report and are encouraged to introduce similar creative activities.”

Actor Linda Marlowe, who played Sylvie Carter a character with dementia in TV soap EastEnders this year, has also welcomed the workshops. To prepare for her acting role, she visited care home residents living with dementia. Ms Marlowe said: “I was there for three days spending time with the residents who had dementia to various degrees. This was invaluable in playing my role in EastEnders. I am now committed to promoting the use of drama and the arts to make a positive difference to help those who are living with dementia”

SOURCE: carehome. co.uk, Angeline Albert

Dementia deaths to rocket by 2040, experts warn in plea for improved care

The number of people who die from dementia is set to almost quadruple in coming years, a new study has found.

Increasing deaths from the condition will contribute to a rocketing number of people who will need end-of-life care, researchers added.

By 2040, it is estimated 219,409 people in England and Wales will die from dementia - a significant rise from 59,199 in 2014.

Experts called for urgent action to address the growing need for end-of-life care services.

The study, published in the journal BMC Medicine, saw experts analyse mortality statistics for England and Wales from 2006 to 2014.

Researchers from the Cicely Saunders Institute at King's College London then calculated the proportion of people who need palliative care, and corresponding rises over the nine-year period.

They estimated that by 2040, the annual number of deaths in England and Wales will rise by 25.4% to 628,659.

As well as predicting soaring numbers of deaths from dementia, researchers also estimated that by 2040, the number of deaths from cancer will increase from 143,638 to 208,636.

They concluded palliative care needs will rise by 42.4% by 2040.

This means 160,000 more people in England and Wales will need such care by 2040.

At present, it is estimated three-quarters of people need some level of palliative care, but researchers believe this will rise to 85% in the coming 23 years.

"By 2040, national data suggests there will be a rise in the prevalence of chronic progressive illnesses, and we believe that many of these will require symptom relief and palliative care," said lead author Dr Simon Noah Etkind from the Cicely Saunders Institute.

"We estimate that at least 85% of deaths in 2040 will require some form of palliative care and we can predict a shift towards dementia as a greater contributor to palliative care need."

Co-author Professor Irene Higginson (pictured) added: "There is an urgent need to act now to transform health, social and palliative care services to meet the projected growth in palliative care need."

Commenting on the study, Simon Jones, from the charity Marie Curie, which provides care and support for people with terminal illnesses, said: "We need to radically rethink how we care for people at the end of their lives, to ensure everyone with a terminal illness gets the range of support they need, when they need it.

"We need to start that process now, before we reach crisis point."

Alzheimer's Society director of campaigns and partnerships Rob Burley said: "Dementia is set to be the 21st century's biggest killer.

"It is the only leading cause of death that we can't cure, prevent or slow down.

"This predicted fourfold increase in dementia deaths is a wake-up call to provide more dementia-appropriate palliative care services in the community."

Dr Matthew Norton, of Alzheimer's Research UK, said: "The figures from this study are very alarming, but we can prevent this becoming the reality if we invest now in pioneering research."

SOURCE: care appointments.co.uk, Ella Pickover

Dementia patients should be fitted with GPS trackers to find them within seconds of going missing, expert claims

Professor June Andrews, OBE, is adamant the chip under their skin could save many families the anxiety and distress if their relative goes missing

Gadgets of this kind are inserted underneath the skin and are used in some countries but not currently in the UK.

Professor Andrews, who has written numerous books on dementia, has since signed over her power of attorney to her daughter for when the 'time comes'.

She said: 'A huge amount of family anxiety is caused when someone goes missing, to the person and the family.

'A huge amount of police money is spent on it and in many ways it’s actually wasted time.

'The devices can also alert you if the person stops moving for a long time. You can have a movement sensor into it. 

'If someone bumps into something or falls over, it alerts you. They are getting more and more sophisticated.' 

Professor Andrews, who now works independently to improve the lives of people with dementia, is in favour of subcutaneous trackers (stock)

There is a growing economy of elderly tracking and tagging devices, from pocket GPS trackers to wearable soles.

The increasingly popular gadgets can be bought online for as little as £40 and require a battery and mobile phone SIM card. 

But critics have previously responded in fury to the tracking device suggestions, calling for the 'human rights' of each person to be 'thoroughly considered'. 

However, Professor Andrews hit back at the claims. She said: 'We know there’s a news story that says, old people are being tagged like criminals.

'The general, sensible response to that is, actually it’s better than being hunted like a dog.'

It is estimated that more than 60 per cent of people living with dementia can at some point start to wander off.

The disease, which affects around 850,000 people in the UK and more than 35 million worldwide, can cause disorientation. 

Dr Hilda Hayo, chief executive at Dementia UK said: 'We believe the use of GPS tracking systems can in some situations be useful to safeguard a vulnerable person, but must only be implemented on a case by case basis. 

'The decision to use GPS technology should be based on the best interests of the person’s safety and ideally having gained their consent. 

'Dementia UK stresses that there are civil liberties and ethical issues to take into account when monitoring an individual’s movements, which must be balanced against the significant harm that may come to them. 

'Their human rights, including their best interests and consent, or that of their carers, should be thoroughly considered.'

ARE TRACKING DEVICES ALREADY USED IN BRITAIN?

Many tracking device schemes are already underway across Britain, including one announced last week by the Metropolitan Police.

It said it was behind vulnerable patients wearing the state-of-the-art technology as a necklace, bracelet or key ring to locate them within seconds.

Sussex Police became the first force to fit patients with GPS tracking devices in 2013, making the move to try and save time and money when they go missing.

While a similar scheme announced by Hampshire County Council last year has proven to be a success.

The number of missing person episodes in this region of the country for people fitted with the trackers has more than halved, figures show.   

In Japan, health officials in one city have gone one step further and allowed people to add barcodes to the thumbnails and toenails of dementia patients.

These record their name, address and who to contact in case they are found walking the streets disorientated by police.  

SOURCE: MailOnline, Stephen Matthews

New tax needed to fund NHS and care, says ex-minister

A new tax is needed to ensure the UK has a properly funded health and social care system, doctor and ex-Conservative health minister Dan Poulter has said.

The Central Suffolk and North Ipswich MP told the Observer that difficulties in arranging social care for patients was having a major impact on hospitals.

Raising National Insurance "offers one of the simplest ways forward", he said.

The Department of Health said its plan to introduce a cap on care costs in England in 2020 had not changed.

Mr Poulter stepped down from his Department of Health post last year and now works as an MP and a part-time doctor in the NHS.

He told the Observer: "On the hospital wards I often see people who are medically fit to go home, but who are forced to stay in hospital because of difficulties arranging their social care package, or because of a lack of appropriate housing...

"A long-term plan to ensure a properly funded and sustainable health and social care system is urgently required."

'Legitimate debate'

The government's policy to limit care costs to £72,000 for the over-65s and younger adults with disabilities were delayed from last April after councils, which provide the facilities, wrote to ministers citing "enormous pressures".

But Dr Poulter, who had been charged with steering the plan through Parliament, suggested the flagship policy now has little chance of being implemented because of increasing costs.

He said a "health and care tax - perhaps introduced through raising national insurance" would provide a guaranteed income stream and "allow a legitimate debate about what is an appropriate level of taxation required to ensure a sustainable funding settlement".

A 1p in the pound hike in both employee and employer National Insurance contributions was used by Labour in its 2002 budget to pay for a £40bn rise in NHS spending over five years.

Dr Poulter's comments come after it was revealed plans are being drawn up that could see cuts to NHS services across England to meet £22bn in efficiency savings by 2020-21.

The Department of Health said it had protected the NHS in England by giving it an extra £10bn and any changes would involve reorganising local services to improve patient care.

Addressing Mr Poulter's comments, a DoH spokeswoman said: "This government is committed to ensuring that those in old age can access care that is both affordable and dignified.

"The position on the care cost cap hasn't changed. Last year, a new timetable was set out with the introduction of the cap in 2020 and we are now working with the insurance industry and others to make sure we can introduce these reforms."

But Richard Murray, of the King's Fund think tank, said tackling the "growing crisis" in social care would be a key test of Prime Minister Theresa May's vow to lead a nation that works for everyone, not just the privileged.

He said: "England remains one of the few major advanced countries that has not reformed the way it funds long-term care in response to the needs of an ageing population.

"A frank and open debate is needed on how to fund health and social care on a sustainable basis into the future, recognising that a long-term strategy will exceed the lifetime of a single Parliament."

SOURCE: NHS