New ‘Continuing Healthcare’ framework documents – changes from the old

Here’s a useful info letter from Mills and Reeve, a law firm. It describes the changes in the recent Department of Health guidance on Continuing Healthcare. This is the funding for people who need homecare – it’s more generous and flexible than social services community care funding, if you are eligible. The ‘National Framework explains the whole thing and tells the professionals (usually nurses) how to do the assessments. Crucial to people who want to fight a decision. Because the order of the new framework has changed, the Mills and Reeve info has a table showing where you can find old topics in new places.

Link to the Mills and Reeve newsletter.

You can download a new Framework document from here.

If you’re interested in getting regular legal newsletters, link to my ‘I find it useful’ listing.

No comeback for poor care in privatised healthcare?

The Care Quality Commission (the health and social care regulator) has published its annual ‘state of care’ report, which has had some press coverage, mainly about poor standards of staffing and respect in care in quite a lot of nursing homes and hospitals.

Link to the CQC ‘State of Care’ report here, or click the pic.

It is interesting to surmise what the consequences of this kind of information is. One sign is an interesting article by a lawyer who supports patients making ‘clinical negligence’ claims. She says that because older people have more complex needs, they are likely to be let down by poor staffing, and poor record-keeping may mean there is no comeback, because there is not sufficient evidence of negligence in the records.

I’m more cynical than she is. Could private sector providers (where recording is worse anyway) purposely degrade recording so that there is no comeback? Will this be another consequence of poor private sector care provision in the newly privatised NHS?

Link to the law commentary.

Here’s an excerpt from what she says:

It is a frankly astonishing that almost a quarter of the homes inspected did not have adequate staffing levels. These are the nursing homes which provide for complex health needs. 16% of hospital services failed to meet the staffing requirement levels that the CQC considered appropriate. This is a significant number of hospitals failing to provide sufficient staff to deal with care needs of patients.

The other issue which was equally important, particularly for lawyers, is that as a result of the increased pressure on limited employees, the level of appropriate record-keeping was deteriorating. In addition, so was the management of medicines.

As lawyers we depend a great deal on the medical records that were contemporaneously completed. In the private sector medical records can often be poor. In the NHS sector they tend to be more thorough. It is a worrying aspect of the report that across the board record-keeping was beginning to deteriorate. Not all institutions were poor, but a significant minority were not providing the level of record-keeping that should be expected.

And further on:

For clinical negligence lawyers it is likely that we will see an increase in potential claims to consider. What is worrying, however, in addition is that, as lawyers, we may not be able to ascertain fully what is happening because the medical records have not been completed properly.

Whilst by far the majority of inspections clearly demonstrated adequate care, there is a significant minority where the care does not meet the standard and where it is much more likely that serious accidents will occur. At the same time as the legal system is changing so that it will become more difficult for claimants to seek compensation for clinical negligence, we are dealing with a health care system which is failing a number of its own clients. The overall result may be fewer claims to the NHS and other bodies, but that does not mean that the negligence is not happening. It does not solve the problem of what happens after somebody has had an accident and requires further care as a result.

Changes in liberty safeguards:kidding yourself you’re not locking someone in

The Deprivation of Liberty safeguards are part of the Mental Capacity Act 2005 which require care agencies to get authorisation before restraining people, for example refusing to let them leave hospital or confine them in their room. An interesting result of the changes to the NHS is that local authorities are taking over as supervising bodies for hospitals, because the Primary Care Trusts are being abolished (the local authorities have been given money to do this; another example of the costs of the reorganisation which I bet the Department of Health didn’t think about).

Link to Department of Health document.

This is interesting, because there is a widespread view that hospitals don’t bother all that much with the safeguards. Neither do a lot of care homes, but at least the local authorities that are supervising them are not usually also the managers. It will be interesting to see whether this change makes much of a difference.

A related slice of information comes out of the recent CQC report on care services (see p 103).

There were a significant number of concerns about the use of seclusion to manage challenging  behaviours. Safeguards were not always implemented and, in particular, poor recording did not give a clear picture of the use of seclusion and longer-term segregation.

A range of different terms were used to describe circumstances in which people might effectively be detained in seclusion: “Nursed in his room”, “Placed in the low-stimulus area for a sustained period” or “Chose to be in the safe-care suite”.

It seems that nurses and managers may be kidding themselves that they are not locking people up, when they are doing the equivalent and calling it caring. Nurses and social and care workers (and their managers) need to be a bit more self-critical about what they are really doing.

Link to the CQC report.

National End of Life Care Prog giveaway

The National End of Life Care Programme says it’s got hard copies of its publications to give away free. What do you think its logo signifies? Stepping delicately towards the end of life?

NEOLCP publications website.